From Awareness to Action: Combating Racism in Health Systems

2. Please select the choice(s) that best describe your Race/Ethnicity:

• American Indian or Alaska Native
• Asian
• African American, or Black
• Hispanic or Latino
• Native Hawaiian or Other Pacific Islander
• White
• Other

4. Using the scale below, indicate your response to the following statements:
 

Space Cell	Strongly Disagree	Disagree	Undecided	Agree	Strongly Agree
I work in a system that actively addresses racism and other forms of oppression.	I work in a system that actively addresses racism and other forms of oppression.: Strongly Disagree	I work in a system that actively addresses racism and other forms of oppression.: Disagree	I work in a system that actively addresses racism and other forms of oppression.: Undecided	I work in a system that actively addresses racism and other forms of oppression.: Agree	I work in a system that actively addresses racism and other forms of oppression.: Strongly Agree
I work in a system where policy and practices impact disparate groups in a negative way.	I work in a system where policy and practices impact disparate groups in a negative way. : Strongly Disagree	I work in a system where policy and practices impact disparate groups in a negative way. : Disagree	I work in a system where policy and practices impact disparate groups in a negative way. : Undecided	I work in a system where policy and practices impact disparate groups in a negative way. : Agree	I work in a system where policy and practices impact disparate groups in a negative way. : Strongly Agree
I work in a system who that takes into account the lived experience of the people we served.	I work in a system who that takes into account the lived experience of the people we served. : Strongly Disagree	I work in a system who that takes into account the lived experience of the people we served. : Disagree	I work in a system who that takes into account the lived experience of the people we served. : Undecided	I work in a system who that takes into account the lived experience of the people we served. : Agree	I work in a system who that takes into account the lived experience of the people we served. : Strongly Agree

5. What type of system best describes the system in which you are employed?

• Savior-designed
• Ally-designed
• Equity empowered

6. Based on my racial identity there are times I feel objectified in the system for which I work. 

• True
• False

7. Please rate the how little or how much your race impacts your ability to do your job.

Not at all	Rarely	Sometimes	Often	Always
Not at all	Rarely	Sometimes	Often	Always

10. Please indicate your response for the following (1 being least satisfied and 7 being most satisfied):
 

Space Cell	1	2	3	4	5	6	7
How satisfied were you overall with the quality of the presentations?	How satisfied were you overall with the quality of the presentations?: 1	How satisfied were you overall with the quality of the presentations?: 2	How satisfied were you overall with the quality of the presentations?: 3	How satisfied were you overall with the quality of the presentations?: 4	How satisfied were you overall with the quality of the presentations?: 5	How satisfied were you overall with the quality of the presentations?: 6	How satisfied were you overall with the quality of the presentations?: 7
How useful will this webinar be to your work going forward?	How useful will this webinar be to your work going forward?: 1	How useful will this webinar be to your work going forward?: 2	How useful will this webinar be to your work going forward?: 3	How useful will this webinar be to your work going forward?: 4	How useful will this webinar be to your work going forward?: 5	How useful will this webinar be to your work going forward?: 6	How useful will this webinar be to your work going forward?: 7

11. Copy of Please indicate your response for the following (1 being least satisfied and 7 being most satisfied):
 

Space Cell	1	2	3	4	5	6	7
How satisfied were you overall with the quality of the presentations?	How satisfied were you overall with the quality of the presentations?: 1	How satisfied were you overall with the quality of the presentations?: 2	How satisfied were you overall with the quality of the presentations?: 3	How satisfied were you overall with the quality of the presentations?: 4	How satisfied were you overall with the quality of the presentations?: 5	How satisfied were you overall with the quality of the presentations?: 6	How satisfied were you overall with the quality of the presentations?: 7
How useful will this webinar be to your work going forward?	How useful will this webinar be to your work going forward?: 1	How useful will this webinar be to your work going forward?: 2	How useful will this webinar be to your work going forward?: 3	How useful will this webinar be to your work going forward?: 4	How useful will this webinar be to your work going forward?: 5	How useful will this webinar be to your work going forward?: 6	How useful will this webinar be to your work going forward?: 7